New diabetes HEDIS blood pressure quality measure: potential for overtreatment.

Choe HM, Bernstein SJ, Standiford CJ, Hayward RA. New diabetes HEDIS blood pressure quality measure: potential for overtreatment. The American journal of managed care. 2010 Jan 1; 16(1):19-24.

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

If you have VA-Intranet access, click here for more information vaww.hsrd.research.va.gov/dimensions/

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.    Search Dimensions for VA for this citation
* Don't have VA-internal network access or a VA email address? Try searching the free-to-the-public version of Dimensions

Search for Abstract from PubMed

---

Abstract:

OBJECTIVE: To examine reasons for failing to meet the new Healthcare Effectiveness Data and Information Set (HEDIS) blood pressure (BP) measure for diabetes patients (BP < 130/80 mm Hg), which may not accurately identify poor-quality care and could promote overtreatment through its performance incentives. STUDY DESIGN: Retrospective chart review. METHODS: We formed 2 cohorts of diabetes patients in 9 general medicine clinics in an academic healthcare system. Cohort A (n = 124) failed the new HEDIS measure but passed the old measure (systolic blood pressure [SBP] 130-139 and diastolic blood pressure [DBP] < 90 mm Hg; or SBP < 140 and DBP 80-89 mm Hg). Cohort B (n = 125) failed the old measure (SBP > or = 140 and/ or DBP > or = 90). We reviewed medical records to ascertain clinician response to elevated BP. RESULTS: Physicians documented treatment changes in only 4% and 28% of cohort A and B patients, respectively. Refractory systolic hypertension was common in those aged > or = 65 years; 60% of those in cohort B and 58% in cohort A took 3 or more antihypertensive medications and/or had a diastolic BP below 70 mm Hg. CONCLUSIONS: We identified a substantial cohort of elderly diabetes patients with DBP < 70 mm Hg who were on 3 medications at adequate doses, but who did not meet the current performance measurement criteria (140/90 or 130/80 mm Hg). We suggest that such patients be excluded from performance measures, or if included, be noted for special attention by clinicians to balance intensification with risk.